=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073944187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BRIGGS MA, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2013
-----------------------------------------------------
Last Update Date | 07/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 519 SOUTH AVE SE
-----------------------------------------------------
City | EYOTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55934-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-261-2981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 SOUTH AVE SE
-----------------------------------------------------
City | EYOTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55934-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-261-2981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC00507
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------